Handleless clamping device

ABSTRACT

The present invention relates to surgical clamps and clamp devices that provide a handle-free surgical field and to methods of operating such clamps and clamp devices. Such methods may include moving a second rotating element relative to a first rotating element such that the rotational axis of the second rotating element is not parallel to the rotational axis of the first rotating element and rotating the first rotating element about the rotational axis of the first rotating element to cause rotation of the second rotating element about the rotational axis of the second rotating element. The rotation of the second rotating element causes translation of a first actuation element along the rotational axis of the second rotating element. The translation of the first actuation element causes pivotal motion of the first jaw portion towards the second jaw portion. Other methods and devices are provided.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 13/942,390 filed on Jul. 15, 2013, entitled “HandlelessClamping Device.” which is a continuation of the divisional applicationfiled on Dec. 15, 2008 under U.S. patent application Ser. No.12/335,431. (issued under U.S. Pat. No. 8,506,590 on Aug. 13, 2013)which claims priority to the non-provisional application filed on Mar.25, 2003 as U.S. patent application Ser. No. 10/397,915 (issued underU.S. Pat. No. 7,588,585 on Sep. 15, 2009) and U.S. ProvisionalApplication No. 60/368,074, filed Mar. 26, 2002, the disclosures ofwhich are herein incorporated by reference in their entirety.

FIELD OF THE INVENTION

This invention relates to surgical instruments for occluding andgrasping hollow organs as well as grasping solid tissues. Specifically,various clamp devices designed for minimally invasive surgery or formaximizing space in the surgical field are described.

BACKGROUND OF THE INVENTION

Surgical procedures often require retraction, grasping, and the full orpartial occlusion of organs such as blood vessels, bile ducts, andintestines, and other various tissues. Traditionally, surgical clampshaving pivotable jaws and a handle with a ratchet mechanism are used forthis purpose. e.g., Kocher and Kelly clamps. The clamp jaws are actuatedby manipulation of the handle at the proximal end of the clamp. However,these clamps are often bulky, and once deployed their handles usuallyget in the way, obstructing the surgeon's field of view or access toother locations at the surgical site. With the advent of less invasivesurgical procedures, surgical sites are becoming smaller and smaller,and obstruction by clamp handles is becoming more problematic. Thus, itwould be advantageous to provide a surgical clamp that reduced or eveneliminated the bulky handle portion of traditional clamps.

SUMMARY OF INVENTION

The present invention provides various surgical clamps that reside in asurgical field without a bulky handle portion. The surgical clampsgenerally include first and second body portions that are pivotallyconnected at their proximal ends. The first and second body portionsfurther include first and second jaw portions extending from the firstand second body portions respectively. The clamps include a moveabledrive element connected between the first body portion and the secondbody portion such that movement of the drive element pivotally moves thebody portions relative to one another. Movement of the drive element istypically either rotational or translational.

The surgical clamps may be provided with, and releasably attached to, aclamp applier so that the drive element may be actuated from a positiondistal to the clamp jaw portions. In some instances, the clamp applierslidably engages a clamp along a wire. Once engaged, control arms on theclamp applier may be approximated to actuate the drive element.

In one variation, the drive element includes an orthogonally situatedthreaded rod and thumbscrew. In another variation, the drive elementincludes a worm and worm wheel assembly. In a further variation, thedrive element is composed of a threaded rod with a mounted nut that islongitudinally aligned with the clamp jaw portions. In yet anothervariation, the drive element includes a spring-loaded ratchet slide thatcloses a first jaw portion by proximal movement of the ratchet slide.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a surgical clamp according to onevariation of the invention having a drive element situated orthogonal tothe jaw portions.

FIG. 2 is a partial cross-sectional view of a surgical clamp accordingto another variation of the invention having a drive element composed ofa worm and worm wheel assembly.

FIG. 3 is a partial cross-sectional view of a surgical clamp accordingto another variation of the invention having a drive element actuated byrotation of a threaded rod through a nut.

FIG. 4 is a partial cross-sectional view of a surgical clamp accordingto another variation of the invention having a translationally actuateddrive element.

FIG. 5 is a perspective view of a clamp applier according to onevariation of the invention.

FIG. 6 is a perspective view of another clamp applier according toanother variation of the invention disengaged from the clamp in FIG. 3having a rotationally actuated drive element.

FIGS. 7A-7D show a clamp applier according to another variation of theinvention that slides along a wire to engage the surgical clamp of FIG.4 and actuate its drive element. FIG. 7A is a side view of the clamp andclamp applier disengaged, and the wire upon which the clamp applierslides. FIG. 7B is a cross-sectional view of the clamp applier. FIG. 7Cis a perspective view of the clamp applier engaged with the clamp. FIG.7D is a partial cross-sectional view of the applier engaged with theclamp.

FIGS. 8A-8D illustrate another variation of a clamp applier fortranslationally actuating a drive element. FIG. 8A shows a perspectiveview of the clamp and clamp applier disengaged along a wire. FIG. 8B isa side view of the clamp and clamp applier engaged. FIG. 8C is a partialcross-sectional view of the translationally actuated drive element. FIG.8D is an enlarged side view of the gearbox.

DETAILED DESCRIPTION OF THE INVENTION

The surgical clamp devices of this invention may take various forms, butas further described below, are generally designed to have first andsecond body portions that are pivotally connected at their proximalends. The body portions further include first and second jaw portionsthat extend from the first and second body portions, respectively.Typically, the body portions are pivotally moved by rotational ortranslational actuation of a drive element. A clamp applier may also beused to deploy the clamp if desired. The surgical clamps of thisinvention can be used in a variety of open, laparoscopic, or endoscopicprocedures, including those requiring occlusion of hollow organs. e.g.,blood vessels, ureters, bile ducts, intestines, and the like.

The surgical clamping devices may be made from any biocompatiblematerial including, but not limited to, stainless steel and any of itsalloys; titanium alloys, e.g., nickel-titanium alloys; polymers. e.g.,polyethylene and copolymers thereof, polyethylene terephthalate orcopolymers thereof, nylon, polyurethanes, fluoropolymers, poly(vinylchloride); and combinations thereof.

Surgical Clamps

As shown in FIG. 1, the surgical clamps of this invention generallyinclude a first body portion 14 and a second body portion 16. First jawportion 13 and second jaw portion 15 are connected to, and extend fromfirst body portion 14 and second body portion 16, respectively. Bodyportions 14 and 16 are linked together by, and pivotable about, pivot18. Pin 20 of the second body portion 16 is received within slot 22 ofthe first body portion 14 as a guide for rotation of the body portionsabout the pivot 18 and to restrict the range of rotational motion aboutthe pivot 18.

Jaw portions 13, 15 and body portions 14, 16 may be sized, shaped,and/or aligned according to their intended use depending on such factorsas the hollow organ or solid tissue clamped, surgeon preference, type ofprocedure involved, and the like. For example, jaw portions 13, 15 maybe straight or curved, long or short, or designed such that whendirectly opposed, they are transversely or vertically aligned with eachother. Depending on their material constitution, jaw portions 13, 15 mayalso be designed to have varying degrees of flexibility and stiffnessalong their lengths such that they are malleable at their distal ends,and can be shaped by the surgeon just prior to clamp deployment.

In one variation, jaw portions 13, 15 include inserts 17, 19 thatcushion a clamped tissue.

The inserts 17, 19 may be formed of an elastomer or other like materialand can further be textured to improve the grip of the insert on theclamped tissue. The inserts may be affixed to the jaw portions 13, 15 bytechniques known in the art, such as those described in U.S. Pat. Nos.6,099,539 and 6,206,896, each of which is incorporated herein byreference in its entirety. Preferably, the inserts are fixed to the jawportions using a flexible elongate attachment member configured forreceipt in a corresponding channel provided in the jaw portions, such asthose described in U.S. Pat. Nos. 6,228,104 and 6,273,902, and U.S.application Ser. No. 09/594,291, each of which is incorporated herein byreference in its entirety.

Drive Elements

A moveable drive element is usually positioned between, and connects,the first and second body portions. The drive element may be configuredto be distal or proximal to elements such as pin 20 and slot 22 in thebody portions, as shown in FIG. 1. Actuation of the drive element,either by a rotational movement or a translational movement, pivotallymoves the body portions, thereby opening or closing the jaw portions.When appropriate, the drive elements are configured to be non-backdrivable. e.g., by making a fine pitch between screw threads.

In one variation, provided in FIG. 1, the drive element comprises athreaded rod 30 which is situated orthogonal to the jaw 13, 15 and body14, 16 portions, and which is integrally connected to a thumbscrew 32 atapproximately the midpoint of the rod 30. The rod 30 has a left handthread on one side of the thumbscrew and a right hand thread on theother side. Rod ends 34, 36 are threaded through nuts 38 and 40 whichare disposed within channels 42 and 44 that extend through body portions14 and 16, respectively. The nuts are mounted within the channels suchthat they remain aligned with the screw axis when body portions rotateabout pivot 18. To actuate the clamp and thereby move the jaw portionseither together or apart, the thumbscrew 32 is rotated, which in turnrotates the rod 30. As the rod 30 rotates, it threads through andapplies an axial force on the nuts 38, 40, which in turn apply a forceonto each body portion 14, 16 and jaw portion 13, 15. The direction ofthumbscrew rotation will determine whether the jaws portions open orclose. The clamp may also be ergonomically designed to enable thesurgeon to hold the clamp in one hand and rotate the thumbscrew with asingle digit, e.g., a thumb or forefinger.

In another variation, as shown in FIG. 2, the drive element includes aworm 200 and worm wheel 202 for actuating the jaw portions 204, 206. Insuch a variation, first and second body portions 208, 210 are againpivotally connected. The worm 200 is rotatably mounted in the first bodyportion 208 with an axis of orientation generally parallel to the firstjaw portion 204. The worm 200 is connected to a drive shaft 212 whichextends proximally from the first body portion 208 and is coupled to anactuating knob 214. The rotational axis of the actuating knob 214coincides with the drive shaft and worm axis. The worm wheel 202 istypically integrally formed with the second body portion 210 andincludes gear teeth 216 arranged in an arc about the pivot 220 thatcouples the first and second body portions 208, 210 together. Gear teeth218 on the worm 200 mesh with the gear teeth 216 of the worm wheel 202.Rotation of the actuating knob 214 turns the drive shaft 212, which inturn rotates the worm 200. Rotation of the worm 200 drives the wormwheel 202 and causes movement of the second body portion 210 about thepivot 220, thus moving the second jaw 206 toward or away from the firstjaw 204, depending on the direction of rotation of the worm 200.

In a further variation, shown in FIG. 3, the drive element of clamp 301includes a threaded rod 300 which is axially aligned with the first andsecond jaw portions 302, 304 when they are in the clamped position. Therod 300 is connected to a drive shaft 314 which extends proximally fromthe drive element. The drive shaft 314 couples an actuating knob 312mounted on the drive shaft 314 to the rod 300. The rod 300 is threadedthrough a nut 306 which is disposed between the first and second bodyportions 308, 310. To actuate the drive element and open or close thejaw portions 302, 304, the actuating knob 312 is rotated, which in turnrotates threaded rod 300. As rod 300 rotates, it threads through andapplies an axial force on the nut 306, which in turn applies a forceonto body portions 308, 310. The direction of rotation of the actuatingknob 312 determines whether the jaw portions 302, 304 open or close.

In yet a further variation, the drive element includes a spring loadedratchet slide. As shown in FIG. 4, the drive element of clamp 401 isaxially aligned with the first and second jaw portions 400, 402 when thejaws are in the clamped position, and is actuated by proximal movementof a ratchet slide 404. A spring 406 having a distal end 405 and aproximal end 403 is concentrically mounted on the ratchet slide 404 andfixedly attached to the distal end 411 of the ratchet slide 404 at itsdistal end 405. The proximal spring end 403 is free to slide along theratchet slide 404 and engage the engaging arm 413 of the first bodyportion 414 when the ratchet slide 404 is moved proximally. One way tomove the ratchet slide 404 is by applying an axial force to a wire 407attached to the proximal end 409 of the ratchet slide. When the wire ismoved proximally, the ratchet slide 404 is also moved proximally, andthe proximal end 403 of the spring 406 engages and compresses itselfagainst engaging arm 413, exerting a force on the first body and firstjaw portion 400, to thereby bring the first jaw portion 400 togetherwith the second jaw portion 402. The spring 406 also serves to increasethe clamping force resolution. Another spring 412 may be coupled to thefirst body portion 414 to aid in movement of the first jaw portion 400.A pawl 408 keeps the jaw portions 400, 402 closed. The pawl 408 rotateswith respect to a pin 417 which is connected to the second body portion418. To release the pawl 408 and open the jaw portions 400, 402, agenerally rotational force sufficient to counter the force supplied by aleaf spring 416 is applied to the pawl 408 to disengage it from theratcheted portion 410 of the ratchet slide.

Clamp Appliers

As will be appreciated, it may be desirable to deploy the surgicalclamps of this invention using a clamp applier, e.g., when the surgicalfield or access to an organ or tissue is limited. The clamp appliers aregenerally releasably attached to one or more applier areas on thesurgical clamps, e.g., the actuating knob, the drive shaft, the firstbody portion, and/or the second body portion, and may employ arotational or translational movement to actuate the drive elements, butin all instances, actuate drive elements from a position distal to thefirst and second jaw portions.

In one variation, as shown in FIG. 5, a clamp applier configured for usewith a surgical clamp having a worm and worm wheel assembly (FIG. 2) ora longitudinally aligned threaded rod and nut (FIG. 3) is provided. Theclamp applier includes a rotating shaft 500 that terminates at itsdistal end in a drive head 502 configured for receipt of a driveelement, e.g., a clamp actuating knob (element 312 in FIG. 3) or a driveshaft (element 212 in FIG. 2). When secured to such an element as aclamp actuating knob 214, 312, the clamp applier may be aligned alongthe rotational axis of the knob or within about 15 degrees, within about30 degrees, or within about 45 degrees of the rotational axis of theknob. The proximal end of the rotating shaft 500 includes a handle 504and a handle actuating knob 506 distal to the handle 504. The handleactuating knob 506 is connected to the rotating shaft 500 at itsproximal end such that rotation of the knob 506 rotates the shaft 500.In use, the drive head 502 of the rotating shaft 500 is releasablyattached to, e.g., a clamp actuating knob. The handle actuating knob 506is manually rotated relative to the handle, which in turn rotates theclamp actuating knob 214, 312 to actuate the clamp jaws portions 204,206, 302, 304 as described above. Or, if the drive head 502, therotating shaft 500, and the handle 504 are fixedly connected, and theactuating knob is rotatably connected to the handle 504, the driveelement may be actuated by holding the actuating knob 506 stationary androtating as a single unit, the handle 504, rotating shaft 500, and drivehead 502 relative to the actuating knob 506. A bracket assembly (notshown), being fixedly connected to the handle, may be used to restrainthe body portions of the clamp from rotating if desired. The handle 504and handle actuating knob 506 may also be variously shaped and sizeddepending, e.g., on the method of clamp deployment, surgeon preference,or type of procedure.

FIG. 6 shows another variation of a clamp applier. In this variation,the distal portion 602 of clamp applier 600 is sized and shaped to graspan applier area of surgical clamp 604. For example, distal portion 602is shown to be curved in FIG. 6 so that it may grasp clamp 604 along itscylindrical V-groove 606 when control arms 608 are approximated (tobring them together). Once releasably attached to clamp 604, the clamp604 may be positioned, e.g., from a location distal to the surgicalfield. A component 610 similar to the clamp applier in FIG. 5 is coupledto the body 612 of the clamp applier 600. The component 610 includes adrive head 614, a rotating shaft 616, and an actuating knob 618,typically fixedly connected. The component 610 is coupled to the body612 of the clamp applier 600 at least at one position along the rotatingshaft 616. In use, after clamp 604 has been positioned, the drive head614 releasably engages any part of a rotationally actuated driveelement, e.g., the drive shaft (212) in FIG. 2. Rotation of theactuating knob 618 rotates the rotating shaft 616 and drive head 614,which thereby rotates the drive element.

The clamp applier may also slide along a wire secured to the clamp toreleasably attach itself to the clamp. The clamp appliers in theseinstances include control arms that are approximated to actuate thedrive element. In one variation, as shown in FIGS. 7A-7D, the clampapplier 700 includes a handle attachment 702, a spring-loaded rear snap704, an outer tube 712, an inner tube 716, a rotator knob 718concentrically mounted on the proximal end 708 of the outer tube, and arelease disc 720 having raised areas 722 concentrically mounted on thedistal end 710 of the outer tube. The clamp applier 700 may beconfigured for use with clamps having drive elements as described inFIG. 4. When wire fitting 706 engages the spring-loaded rear snap 704,the clamp applier 700 is releasably attached to the clamp 401. Pressingdown on the rear snap 704 and pulling the clamp applier 700 away fromthe clamp 401 then disengages the applier 700 from the clamp 401. Forexample, as provided in FIG. 7D, a wire 407 coupled to the ratchet slide404 is placed under tension and moved proximally as the pair of controlarms 714 are squeezed together. Proximal movement of the ratchet slide404 exerts a compressive force on a spring 406 concentrically mounted onthe ratchet slide 404 to exert a force on a first jaw portion 400 tobring it together with the second jaw portion 402. The spring-loadedpawl 408 works to prevent the jaw portions from opening as describedabove. To release the pawl 408, the rotator knob 718 is rotated, whichin turn rotates the outer tube 712 and release disc 720 on the outertube 712. Rotation of the release disc 720 thereby causes the raisedareas 722 on the release disc 720 to exert a downward and rotationalforce on the pawl 408 to release it.

Another variation, particularly useful with a clamp such as shown inFIG. 3, is provided in FIGS. 8A-8D. In this variation, the clamp applier800 is also slid along a wire 802 to releasably attach to the clamp 301.The front and rear control arms 804 and 806, respectively, of the clampapplier 800 are then also squeezed together to actuate the drive elementof the clamp 301, but they are translationally approximated instead ofrotationally approximated. As shown in FIG. 8B, after slidably engagingthe clamp 301, the clamp jaw portions 302, 304 are closed bytranslationally approximating control arms 804, 806. The linear motionof a rack 808 on the rear control arm 806 through a gearbox 810 causesrotation of an inner shaft 812 of the clamp applier 800 and rotation ofa screw head 814 connected to the inner shaft 812. This in turn exerts aforce on a nut 816, which exerts a force on the first jaw portion 302,causing it to close. A slot 818 in the second body portion 820constrains the nut 816 to only move horizontally. Gearbox 810 is shownin greater detail in FIG. 8D, and generally includes a gear shaft 824, apinion gear 826, a first bevel gear 828, and a second bevel gear 830.The pinion gear 826 and first bevel gear 828 are connected to gear shaft824. The second bevel gear 830 is connected to inner shaft 812. Piniongear 826, first and second bevel gears 828, 830, and rack 808 haveteeth. The teeth of the first and second bevel gears contact each other,and the teeth of the pinion gear 826 and rack 808 contact each other.Linear movement of the rack 808 to approximate the control arms 804, 806rotates the pinion gear 826 which rotates the gear shaft 824 and firstbevel gear 828, which rotates the second bevel gear 830 and the innershaft 812 connected to the second bevel gear 830 to actuate the driveelement. Pulling the rear control arm 806 away from the front controlarm 804 opens the first and second jaw portions 302, 304. Aspring-loaded release button 822 is axially fixed to the gear shaft 830but is free to rotate about the gear shaft axis. The release button 822may be pressed to temporarily disengage the gears in the gearbox 810,allowing the user to slide the rear control arm 806 to a differentposition without actuating the jaw portions.

All publications, patents, and patent applications cited herein arehereby incorporated by reference in their entirety for all purposes tothe same extent as if each individual publication, patent, or patentapplication were specifically and individually indicated to be soincorporated by reference. Although the foregoing invention has beendescribed in some detail by way of illustration and example for purposesof clarity of understanding, it will be readily apparent to those ofordinary skill in the art in light of the teachings of this inventionthat certain changes and modifications may be made thereto withoutdeparting from the spirit and scope of the appended claims.

1-7. (canceled)
 8. A medical device comprising: a first body portion anda second body portion; a first jaw portion and a second jaw portion, thesecond jaw portion pivotally coupled to the first jaw portion by thefirst body portion and the second body portion; a drive element coupledbetween the first body portion and the second body portion, the driveelement including a threaded rod and a receiving member, the threadedrod axially aligned with the first and second body portions when thefirst and second jaw portions are in a clamped position; a drive shaftcoupled to the drive element; and an actuating knob mounted on the driveshaft, wherein the drive shaft extends through the actuating knob. 9.The medical device of claim 8, wherein the first body portion is coupledto the first jaw portion, and wherein the second body portion is coupledto the second jaw portion.
 10. The medical device of claim 8, whereinrotation of the actuating knob causes corresponding rotation of thethreaded rod.
 11. The medical device of claim 10, wherein the rotationof the threaded rod causes the threaded rod to apply a first force tothe receiving member in a direction generally parallel with alongitudinal axis of the threaded rod.
 12. The medical device of claim11, wherein the first force causes the receiving member to apply asecond force to the second body portion, the second force causingpivotal motion of the second jaw portion away from the first jawportion.
 13. The medical device of claim 8, wherein rotation of thethreaded rod in a first direction causes the first and second jawportions to move from the clamped position to an open position, andwherein rotation of the threaded rod in a second direction causes thefirst and second jaw portions to move from the open position to theclamped position.
 14. The medical device of claim 8, wherein thethreaded rod is threadedly coupled to the receiving member, and whereinthe receiving member comprises an outer surface coupled to an innersurface of the second body portion.
 15. The medical device of claim 8,wherein the first jaw portion remains fixedly positioned relative to arotational axis of the threaded rod.
 16. The medical device of claim 8,wherein in the clamped position, the first jaw portion and the secondjaw portion are aligned with a rotational axis of the threaded rod, andwherein in an open position, the first jaw portion is aligned with therotational axis of the threaded rod and the second jaw portion is angledrelative to the rotational axis of the threaded rod.
 17. The medicaldevice of claim 8, wherein the receiving member is a threaded nut sizedto receive the threaded rod.
 18. The medical device of claim 8, whereinthe first jaw portion includes a first textured member and the secondjaw portion includes a second textured member, wherein the firsttextured member protrudes from the first jaw portion toward the secondtextured member, and wherein the second textured member protrudes fromthe second jaw portion toward the first textured member.
 19. A method ofoperating a medical device comprising a first body portion, a secondbody portion, a first jaw portion, and a second jaw portion, the methodcomprising: rotating a threaded rod about a rotational axis of thethreaded rod to cause the threaded rod to apply a first force to areceiving member in a direction generally parallel with the rotationalaxis of the threaded rod, wherein the threaded rod is axially alignedwith the first and second body portions when the first and second jawportions are in a clamped position; and applying, by the receivingmember, a second force to the second body portion to cause pivotalmotion of the second jaw portion away from the first jaw portion,wherein the pivotal motion occurs about a single pivot pin.
 20. Themethod of claim 19, wherein the receiving member is positioned betweenthe first and second body portions.
 21. The method of claim 19, whereinrotating the threaded rod includes rotating an actuating knob of themedical device, the actuating knob mounted on a drive shaft that iscoupled to the threaded rod.
 22. The method of claim 19, whereinrotating the threaded rod includes: rotating the threaded rod in a firstdirection to cause the first and second jaw portions to move from aclamped position to an open position; and rotating the threaded rod in asecond direction to cause the first and second jaw portions to move fromthe open position to the clamped position.
 23. The method of claim 22,wherein in the clamped position, the first jaw portion and the secondjaw portion are aligned with the rotational axis of the threaded rod,and wherein in the open position, the first jaw portion is aligned withthe rotational axis of the threaded rod and the second jaw portion isangled relative to the rotational axis of the threaded rod.
 24. Themethod of claim 19, wherein the first jaw portion remains fixedlypositioned relative to a rotational axis of the threaded rod.
 25. Themethod of claim 19, wherein rotating the threaded rod includes rotatingthe threaded rod within the receiving member.
 26. The method of claim25, wherein the receiving member is a threaded nut sized to receive thethreaded rod.
 27. The method of claim 19, wherein the first jaw portionincludes a first textured member protruding toward the second jawportion, wherein the second jaw portion includes a second texturedmember protruding toward the first jaw portion, and wherein applying thesecond force to the second body portion causes pivotal motion of thesecond textured member away from the first textured member.